Comparative Evaluation of the Efficacy of Stepwise Caries Excavation vs Indirect Pulp Capping in Preserving the Vitality of Deep Carious Lesions in Permanent Teeth of Pediatric Patients: An In Vivo Study

Abstract

Aims and objectives: To comparatively evaluate the clinical efficacy of stepwise caries excavation with indirect pulp capping (IPC) in managing the young permanent teeth in pediatric patients who have deep carious lesions.

Materials and methods: Eighty-eight teeth (first/second permanent molars) were included and randomly divided into two groups: group I (stepwise caries excavation) and group II (IPC). For group I, i.e., stepwise caries excavation, in the initial visit, bulk caries removal was done from walls of the cavity, however, soft and infected dentin was left untouched on the pulpal floor. The final excavation was performed after 2 months. The dentin parameters like the color, the consistency, and the humidity of dentin were noted at the first and second visits. A final follow-up to assess the primary outcome, i.e., sustained pulp vitality, was done after 1 year.

Results: When both the groups were compared with each other using the Chi-squared test, a highly significant difference was found (p < 0.05) between them. The success rate of stepwise caries excavation (97.3%) was found to be significantly greater than IPC (82.4%). After doing statistical analysis, a significant difference between stepwise excavation at baseline and at re-entry for parameters like the color, the consistency, and the humidity (p < 0.05), where dentin was observed to be darker in color, harder in consistency, and drier to touch at re-entry was found.

Conclusion: Stepwise caries excavation was considered a safer technique than IPC for preserving the vitality of young permanent teeth. Also, the clinical changes recorded during the re-entry in the case of stepwise caries excavation technique indicated the arrest of the carious process.

Clinical significance: Pulp preservation is of utmost importance especially in the case of young permanent teeth which have open apex to aid in apexogenesis. Failure to do so in maintaining the vitality of pulp before root completion may lead to the unfavorable crown to root ratio resulting in thin dentinal walls which are prone to fracture.

How to cite this article: Manhas S, Pandit IK, Gugnani N, et al. Comparative Evaluation of the Efficacy of Stepwise Caries Excavation vs Indirect Pulp Capping in Preserving the Vitality of Deep Carious Lesions in Permanent Teeth of Pediatric Patients: An In Vivo Study. Int J Clin Pediatr Dent 2020;13(S-1):S92-S97.

Keywords: Deep caries; Indirect pulp capping; Pulp conservation; Stepwise excavation.

Figs 1A to F

Clinical photographs and radiographs depicting stepwise caries excavation of mandibular right first permanent molar: (A) Pretreatment view of the tooth with a deep carious lesion; (B) The pretreatment radiograph shows no apical pathosis, but a deep carious lesion; (C) Clinical photograph showing the cavity preparation (all soft infected dentin left untouched on the pulpal floor); (D) The cavity re-entered at the end of 2-month interval period; (E) Tooth restored permanently; (F) Radiograph of the tooth at 1 year showing no apical pathosis

Figs 2A to F

Clinical photographs and radiographs depicting indirect pulp treatment of maxillary right first permanent molar: (A) Pretreatment view of the tooth with a deep carious lesion; (B) The pretreatment radiograph shows no apical pathosis, but a deep carious lesion; (C) Clinical photograph showing the cavity preparation (all soft infected dentin removed); (D) The cavity immediately after removal of temporary filling with a layer of dycal left behind, at the end of 2-month interval period; (E) Tooth restored permanently; (F) Radiograph of the tooth at 1 year showing no apical pathosis